Gundersen Lutheran Hospital, La Crosse, WI, USA.
J Shoulder Elbow Surg. 2010 Oct;19(7):1049-55. doi: 10.1016/j.jse.2009.11.056. Epub 2010 Mar 24.
Delayed surgical treatment of unstable distal clavicle fractures is associated with a higher complication rate.
Between 1998 and 2008, a retrospective study of 38 patients (average age, 42.9 year) with Neer type II clavicular fractures was performed. Fractures were treated with a hook-plate (22 patients) or with superior locked plate with suture augmentation (16 patients). Patients were divided into acute (27 patients) or delayed (11 patients) treatment groups based on the timing of surgical intervention before or after 4 weeks. All had clinical and radiographic follow-up for 1 year or until fracture union.
Union was achieved in 36 of 38 patients (94.7%). The acute treatment group had an average American Shoulder and Elbow Surgeons score of 77.9 compared with 65.0 in the delayed group. Six complications occurred (15.8%) including 2 infections (5.3%), 1 hardware failure (2.6%), and 3 peri-implant fractures (7.9%). The complication rate was 36.4% in the delayed group vs 7.4% in the acutely treated group (P = .047).
A high rate of union was observed in all cases regardless of timing or method of fixation. Despite a high rate of union, the results of treatment in the delayed group were more problematic. Patients treated with a hook-plate in a delayed fashion had more complications than those treated in an acute fashion (P = .039). Peri-implant fractures occurred only in patients treated with hook-plates.
Surgical timing played a critical role in the outcome and complication rate in treatment of unstable distal third clavicle fractures.
不稳定型锁骨远端骨折的延迟手术治疗与更高的并发症发生率相关。
1998 年至 2008 年间，对 38 例（平均年龄 42.9 岁）Neer 型 II 型锁骨骨折患者进行了回顾性研究。骨折采用钩板（22 例）或带缝线增强的上锁定钢板（16 例）治疗。根据手术干预的时间，将患者分为急性（27 例）或延迟（11 例）治疗组，分别在 4 周之前或之后进行。所有患者均进行了临床和影像学随访 1 年或直至骨折愈合。
38 例患者中有 36 例（94.7%）获得愈合。急性治疗组的美国肩肘外科医生评分平均为 77.9，而延迟组为 65.0。共发生 6 例并发症（15.8%），包括 2 例感染（5.3%）、1 例内固定失败（2.6%）和 3 例植入物周围骨折（7.9%）。延迟组的并发症发生率为 36.4%，而急性组为 7.4%（P =.047）。
无论固定的时间或方法如何，所有病例均观察到高愈合率。尽管愈合率高，但延迟组的治疗结果更成问题。延迟方式使用钩板治疗的患者比急性方式治疗的患者并发症更多（P =.039）。只有使用钩板治疗的患者发生了植入物周围骨折。
手术时机在不稳定型锁骨远端三分之一骨折的治疗结果和并发症发生率方面起着关键作用。
